Azithromycin as Host-Directed Therapy for Pulmonary Tuberculosis: A Randomized Pilot Trial

Area of Science:

• Immunology
• Pharmacology
• Infectious Diseases

Background:

• Investigating host-directed therapies for tuberculosis (TB) to modulate immune responses and reduce inflammation.
• Macrolides like azithromycin have anti-inflammatory and immune-modulatory properties alongside antibacterial effects.
• Azithromycin's potential to enhance inflammation resolution and decrease tissue turnover in TB patients was explored.

Purpose of the Study:

• To evaluate if azithromycin, as an adjunctive therapy, improves inflammation resolution in pulmonary tuberculosis.
• To assess azithromycin's impact on systemic and pulmonary inflammation markers.
• To determine if azithromycin affects extracellular matrix turnover in TB patients.

Main Methods:

• An open-label, randomized controlled trial was conducted.
• Adult patients with drug-susceptible pulmonary TB received standard care with or without azithromycin (250 mg daily) for 28 days.
• Biomarkers of inflammation and tissue turnover were measured in blood and sputum.

Main Results:

• Azithromycin significantly enhanced the reduction of interferon-γ-induced protein-10 (IP-10) in blood.
• Treatment with azithromycin led to significant reductions in sputum neutrophils, neutrophil elastase, and transforming growth factor-β.
• Azithromycin also significantly reduced the collagen degradation marker C4M in blood.
• The addition of azithromycin to standard care was found to be safe.

Conclusions:

• Adding azithromycin to standard tuberculosis treatment helps reduce neutrophilic inflammation in pulmonary TB.
• Azithromycin shows promise as an adjunctive therapy for managing inflammation in tuberculosis.
• Further research may explore azithromycin's role in improving clinical outcomes in TB patients.